Provider Demographics
NPI:1720366792
Name:BANSAL, NEERAJ (MD)
Entity Type:Individual
Prefix:DR
First Name:NEERAJ
Middle Name:
Last Name:BANSAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 S EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-5909
Mailing Address - Country:US
Mailing Address - Phone:909-579-6721
Mailing Address - Fax:
Practice Address - Street 1:901 SAN BERNARDINO RD STE 102
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4988
Practice Address - Country:US
Practice Address - Phone:909-579-6721
Practice Address - Fax:909-579-6737
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-25
Last Update Date:2018-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA117010208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty